Before treatment:
In May 2016, it was hard for Christopher to run and he didn’t know why. His left lower limb was weak. He went to the local hospital and received a B12 injection fifth, 1 month later, his disease became worse, his lower limbs and upper limbs were weak, so he went to the local department of neurology, had a cerebrospinal fluid examination, EMG and MRI. He was diagnosed with Amyotrophic Lateral Sclerosis in September 2016, he took Riluzole twice a day, but his disease wasn’t controlled. At present, he is able to stand and walk by himself, but when he gets nervous, he will fall down, so he uses crutches to help him walk. His stamina is low and it is hard for him to walk long distances. It is hard for him to walk up and down stairs. The muscle power of his upper limbs is weak, but he can do daily work. When he is tired, his tongue becomes stiff. He wants a better life so he came to our hospital and was diagnosed with Amyotrophic Lateral Sclerosis.
His spirits, sleep, diet, urination and bowel movements were normal.

Admission PE:
Bp: 117/86mmHg, Hr: 60/min. Br: 19/min. Temperature: 36.5 degrees. Height: 176cms, weight: 80kg. Christopher’s body type and nutritional situation were normal. There was no injury or bleeding spots on his skin or mucosa, no blausucht, no throat congestion. Chest development was normal, thoracic mobility was basically normal. The respiratory sounds in both lungs were clear. There were no dry or moist rales. The heart beat was powerful with no arrhythmia, and no obvious murmur in the valves. The abdomen was flat and soft, with no masses or tenderness. The liver and spleen were normal. The first toe had slight redness, swelling and pain.

Nervous System Examination: Christopher is alert and he is in good spirits. His speech is clear. His memory, orientation and calculation ability are normal. Both pupils are equal in size and round, their diameter is 3mm, and react well to light, the eyeballs can move freely. There is no nystagmus. The Bilateral forehead wrinkle and nasolabial fold are symmetrical, his tongue is centered, with mild muscle atrophy. The teeth are shown without deflection. The cheeks can be expanded powerfully and his chewing ability is good, the left soft palate can lift powerfully, the right side is weak. The eyes can close normally. The bilateral thenar muscles, hypothenar muscles and interosseous muscles in both hands have atrophy, the left side is obvious. The neck muscles are soft, he can move his head freely. The shrugging strength on the left side is weak. The muscle strength of the upper limbs is at level 4, the right hand gripping strength is at level 4, the left hand gripping strength is at level 3, and the muscle strength of the lower limbs is at level 4. There is fasciculation in all four limbs. The bilateral lower limb muscle tension is higher. Ankle clonus is positive. The tendon reflex in all four limbs is active. The Rossolimo’s sign on the right side is negative, the Rossolimo’s sign on the left side is positive. The Babinski’s sign is negative. The bilateral finger-to-nose test, the rapid alternating movement test and finger-to-finger test are normal. The bilateral heel-knee-tibia test is basically normal. The meningeal irritation sign is negative.

Post-treatment:
After 15 days of treatment, Christopher’s Sat was around 96-98%, the muscle fasciculation had improved. The muscle force of the upper limbs improved, the muscle force of the left upper limb was at level 4+, and the gripping force was at level 4. The muscle force of the right upper limb was at level 5-, the gripping force was at level 5-. The sense of heaviness in the lower limbs was decreased. Christopher’s walking ability improved and his balance became more stable. The first toe had slight redness and swelling during his hospitalization, but after he was given anti-gout treatment, the redness and swelling had mostly disappeared.